Departments of Pediatrics and Adolescent Medicine.
Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
J Pediatr Hematol Oncol. 2022 Jan 1;44(1):e160-e167. doi: 10.1097/MPH.0000000000002258.
Bloodstream infections (BSIs) adversely affect clinical outcome in children with cancer. Over 1 decade, this retrospective cohort study describes pathogen distribution in BSIs and antimicrobial susceptibility against empirical antibiotics frequently prescribed in children with cancer. The antibiotic efficacy was evaluated through the determination of minimal inhibitory concentrations for piperacillin-tazobactam and meropenem and by disk diffusion for remaining antibiotics. From 2004 to 2013, 398 BSIs occurred in 196 children with cancer (median age: 5.4 y), resulting in 457 bacteria. Overall, 266 (58.2%) were Gram-positive, and 191 (41.8%) were Gram-negative with a significant Gram-positive increase over time (P=0.032). Coagulase-negative staphylococci (74, 16.2%), viridans group streptococci (67, 14.7%), Escherichia coli (52, 11.4%), and Staphylococcus aureus (39, 8.5%) were the most common pathogens. Susceptibility to piperacillin-tazobactam (95.9%, P=0.419) and meropenem (98.9%, P=0.752) was stable over time, and resistance was observed among viridans group streptococci against piperacillin-tazobactam (18%) and meropenem (7%) and among Enterobacterales against piperacillin-tazobactam (3%). Vancomycin showed 98% Gram-positive activity, gentamicin 82% Gram-negative activity and ampicillin, cefotaxime, and cefuroxime were active in 50%, 72%, and 69% of pathogens, respectively, and BSI-related mortality was 0%. In conclusion, over 1 decade, we report an increase in Gram-positive BSIs, and stable, low-resistance rates against currently recommended empirical antibiotics, piperacillin-tazobactam and meropenem.
血流感染（BSI）会对癌症患儿的临床预后产生不良影响。本回顾性队列研究在过去 10 年中描述了 BSI 中的病原体分布以及经常用于癌症患儿的经验性抗生素的药敏情况。通过测定哌拉西林-他唑巴坦和美罗培南的最小抑菌浓度以及其余抗生素的药敏纸片扩散法来评估抗生素的疗效。2004 年至 2013 年期间，196 名癌症患儿共发生 398 例 BSI（中位年龄：5.4 岁），共分离出 457 株细菌。总体而言，革兰阳性菌 266 株（58.2%），革兰阴性菌 191 株（41.8%），革兰阳性菌呈明显增加趋势（P=0.032）。凝固酶阴性葡萄球菌（74 株，16.2%）、草绿色链球菌（67 株，14.7%）、大肠埃希菌（52 株，11.4%）和金黄色葡萄球菌（39 株，8.5%）是最常见的病原体。哌拉西林-他唑巴坦（95.9%，P=0.419）和美罗培南（98.9%，P=0.752）的药敏率保持稳定，而草绿色链球菌对哌拉西林-他唑巴坦（18%）和美罗培南（7%）以及肠杆菌科细菌对哌拉西林-他唑巴坦（3%）的耐药率有所增加。万古霉素对革兰阳性菌的活性为 98%，庆大霉素对革兰阴性菌的活性为 82%，氨苄西林、头孢噻肟和头孢呋辛对病原体的活性分别为 50%、72%和 69%，BSI 相关死亡率为 0%。总之，在过去的 10 年中，我们报告了革兰阳性菌 BSI 的增加，以及对目前推荐的经验性抗生素哌拉西林-他唑巴坦和美罗培南的稳定、低耐药率。
